11/11/2022
This is a 30 yo male who presented to me 2 weeks after a laceration to his forearm from a broken glass door. (Picture 1) He had dense numbness to his median nerve distribution, absent thumb opposition and multiple finger flexion deficits.
During exploration, he was found to have tendon lacerations (blue arrows) and a scarred median nerve with a large zone of injury (red arrow). In these cases, I find it useful to stay organized in a checklist to remember which structures are injured (Picture 3). I repaired the tendons and then resected the nerve back to healthy fascicles (Picture 4).
I utilized a nerve stimulator to locate the motor and sensory bundles and under a microscope, repaired the nerve using two 3-4 mm nerve allografts. (Picture 5 and 6)
The video in the comments shows the patient 6 months out. He can make a composite fist and has 7-8 mm two point discrimination to the fingers. His opposition and palmar abduction is weak but intact.
Tough case but overall thrilled with the result.
Big thanks to our amazing occupational therapists at Duly Health and Care that helped to rehab this patient. The patient consented to have this case posted in a public fashion.
